Summary
Overview
Work History
Education
Skills
Timeline
Generic

LaShawnda Wilson

Dallas,TX

Summary

Strong problem-solving abilities, devoted to data integrity with proficient Microsoft Office suite. High customer service standards, conflict resolution proficiency skills. Paying close attention to detail and making sure all patients are treated with respect. Having empathy for each of their needs. Time management and always implementing HIPPA and taking close to 50-75 calls daily.

Experienced with managing sales and customer support teams to enhance overall performance. Utilizes strategic planning and customer relationship management to drive business objectives. Track record of effectively leading teams and resolving complex customer issues.

Diligent [Desired Position] with solid background in managing sales and customer support teams. Successfully led initiatives that improved customer satisfaction and streamlined sales processes. Demonstrated expertise in team leadership and problem-solving.

Overview

26
26
years of professional experience

Work History

Benefit Verification Specialist

Caremetx
12.2024 - 02.2025
  • Provided exceptional customer service by addressing Payors concerns regarding coverage and out-of-pocket expenses.
  • Managed high-volume caseloads while maintaining strict deadlines for completing benefit verifications and authorizations.
  • Ensured compliance with HIPAA regulations during all aspects of the benefit verification process, protecting patient privacy.
  • Improved payors satisfaction by accurately verifying benefits and providing timely responses to inquiries.
  • Increased accuracy in data entry through meticulous attention to detail when inputting patient demographics and insurance information into the system.

RCR LEAD SALES AND CUSTOMER CARE REPRESENTITVE

CHARTER COMMUNICATION
04.2023 - Current
  • Provided information for customers considering changing internet companies, providing customers with knowledgeable information to inform them what they would be paying for and for how long
  • Providing great costumer skills to earn their business with great intel and information about the product that would be provided for the customer
  • Proactive telephonic outreach and engage customer base as necessary which may involve various customer interactions including but not limited to welcoming new members to the health plan, customer retention and loyalty, quality healthcare initiatives, PCP updates, and other special projects as assigned

Customer Experience Specialist

CARE N' CARE
04.2022 - 04.2023
  • Provide exceptional service across the entire health plan customer base via telephonic, electronically, or in-person methods as applicable
  • Serve health plan member population, prospective members, sales agents, and healthcare providers with issues including but not limited to benefits and eligibility validation claims status and complex claims routing, billing, enrollment, provider search, PCP assignment and appointment setting, provider portal questions, benefits education, appointments and RSVP processing, assist with incoming enrollment facilitation, may assist in supporting health plan events, prior authorization status, pharmacy inquiries, provider dispute, appeals and grievance and other inquiries as presented
  • Identify proper protocol routing, triage, and escalation as necessary as well as full accountability of follow through and close out, always including clear and relative documentation of standard and escalated issues
  • Maintain personal metrics to establish performance levels of the individual and team
  • Responsibilities may vary depending on seasonal business needs
  • Proactive telephonic outreach and engage customer base as necessary which may involve various customer interactions including but not limited to welcoming new members to the health plan, customer retention and loyalty, quality healthcare initiatives, PCP updates, and other special projects as assigned
  • Research and clearly document complex issues across multiple databases and work with support resources, internally and externally, as applicable to resolve customer issues and/or partner with others to resolve escalated issues and submission of appeals, grievances, disputes and/or complaints from the entire customer base

Insurance Verification Specialist

McKesson Medical
11.2021 - 03.2022
  • Provide service across the entire health plan customer base via telephonic, electronically, or in-person methods as applicable
  • Provider dispute, appeals and grievance and other inquiries as presented
  • Identify proper protocol routing, triage, and escalation as necessary as well as full accountability of follow through and close out, always including clear and relative documentation of standard and escalated issues
  • Intake specialist who would register patients with affordable insurance that would cover specific medication needs
  • Research and clearly document complex issues across multiple databases and work with support resources, internally and externally, as applicable to resolve customer issues
  • Verify medical insurance to get patients approved for specific specialty medications

Medical Receptionist

Gateway Diagnostic
10.2021 - 11.2021
  • Responsible for prepping patient for next appointments
  • Taking 20-30 calls daily helping patients set up office and virtual appointments
  • Collecting copayments for office visits
  • Doing consultations for doctors that were on-call in hospitals

Medical Assistant

Your Wellness Clinic
09.2021 - 10.2021
  • Testing patients for Covid
  • Data entry working with different systems to upload patients Covid test results
  • Intake specialist who would register patients
  • Verify medical insurance to get patients approved for testing

Medical Receptionist

Primary Southern Endocrinology
07.2021 - 09.2021
  • Responsible for prepping patient for next appointments
  • Taking 20-30 calls daily helping patients set up office and virtual appointments
  • Collecting copayments for office visits
  • Doing consultations for doctors that were on-call in hospitals

Receptionist

Cornerstone Medical Texas Health Infection Clinic
04.2021 - 07.2021
  • Customer Service-greeting patients, checking patients in and out for appointments collecting payments
  • Working with different systems to do consultations upon doctor's request for patients needing assistance who are still being seen for Inpatient hospitals
  • Verify medical insurance to get patients approved for specific specialty medications

Ambulatory Access Representative

UT Southwestern Medical Center
10.2019 - 04.2021
  • Proactive telephonic outreach and engage customer base as necessary which may involve various customer interactions including but not limited to welcoming new members to the health plan, customer retention and loyalty, quality healthcare initiatives, PCP updates, and other special projects as assigned
  • Customer Service REP who would answer up to 50-70 calls for patients needing assistance getting into My-Chart
  • Working with different systems to connect patients with their doctors, set appointments and update their demographics
  • Working with the EPIC systems to perform multiple medical tasks for patients needing to set appoints and change
  • Identify proper protocol routing, triage, and escalation as necessary as well as full accountability of follow through and close out, always including clear and relative documentation of standard and escalated issues

Medical Insurance Verification Specialist

Pride Living Care
12.2018 - 04.2019
  • Maintained workflow by working closely with patients managing various administrative tasks to ensure timely resolutions for patients' challenges
  • Demonstrated a wealth of knowledge regarding membership contracts by reviewing documents with patient and providing timely responses to inquires
  • Played an integral role in procedural enhancements for office operations by compiling patients' feedback and making recommendations to ensure continuous improvements
  • Verified patient's demographic to qualify them for medically necessary medical needs

Customer Service Technical Support

Express Professionals
03.2015 - 11.2018
  • Drove call center operations by managing inbound calls and provided answers to clients by pinpointing challenges and guiding clients through corrective steps to resolve technical issues
  • With Accordance to call center operations, routinely connected clients via outbound communications and researched documented, and escalation cases to higher level support
  • Thoroughly conducted customer needs analysis and interpreted technical schematics to recommend value driven products and services

Customer Service Representative

Lubbock Saint Supportive Living
02.2011 - 08.2014
  • Responded to telephone inquiries, providing quality service to patients and associates inquiring about the availability intake for future patients
  • Listen to patients and ask probing questions to be a solution provider
  • Documented participants account regarding in and outbound calls
  • Assist participants in navigating healthhub and mypayflex websites
  • Filed updated address, phone, place of employment, and insurance
  • Contacted numerous insurance companies, Medicare, and Medicaid

Customer Service

Southern Cotton Bell Assistant Living
11.2008 - 12.2010
  • Answering 40-65 inbound and outbound calls for customers wanting to sign up for patient programs
  • Listened attentively to patents needs to unsure a positive customer experience
  • Strive to quick complaint resolution; commended by supervisor for the ability to resolve problems on the first call and avoid escalations of issues
  • Performed several task using numerous computer applications and software, including MS Word, Power Point, Excel, and several other programs

Data Entry and Customer Service

Tallahassee Recreational Park
02.2001 - 06.2007
  • Answered 30-50 Inbound calls for customers
  • Updating members demographic for services
  • Renewing customers membership participation

Customer Care Services

TMart Clothing Store
02.1999 - 01.2001
  • Answering calls, helping customers place orders
  • Helped customers pick out clothing
  • Checked customers in and out of store
  • Helped advertise Tmart clothing store

Education

Medical Billing and Coding -

Blinn College
Breham, TX
06.2011

GED -

Texas Education Agency
Fort Worth, TX
02.2008

Skills

  • Multichannel Communications
  • Issue management & Resolution
  • Relationship management
  • Multitask Management
  • Customer Service
  • Call Center Operation
  • Epic
  • Salesforce
  • Silverback
  • Ring Central
  • Citrix
  • MS Outlook
  • DARE systems
  • Insurance Verification
  • Medical Records
  • Medical Office Experience
  • Medical terminology knowledge
  • Documentation accuracy
  • Empathy and patience
  • Call center experience
  • Microsoft Word
  • Claims processing
  • Insurance coverage verification
  • Telephone etiquette
  • Healthcare systems

Timeline

Benefit Verification Specialist

Caremetx
12.2024 - 02.2025

RCR LEAD SALES AND CUSTOMER CARE REPRESENTITVE

CHARTER COMMUNICATION
04.2023 - Current

Customer Experience Specialist

CARE N' CARE
04.2022 - 04.2023

Insurance Verification Specialist

McKesson Medical
11.2021 - 03.2022

Medical Receptionist

Gateway Diagnostic
10.2021 - 11.2021

Medical Assistant

Your Wellness Clinic
09.2021 - 10.2021

Medical Receptionist

Primary Southern Endocrinology
07.2021 - 09.2021

Receptionist

Cornerstone Medical Texas Health Infection Clinic
04.2021 - 07.2021

Ambulatory Access Representative

UT Southwestern Medical Center
10.2019 - 04.2021

Medical Insurance Verification Specialist

Pride Living Care
12.2018 - 04.2019

Customer Service Technical Support

Express Professionals
03.2015 - 11.2018

Customer Service Representative

Lubbock Saint Supportive Living
02.2011 - 08.2014

Customer Service

Southern Cotton Bell Assistant Living
11.2008 - 12.2010

Data Entry and Customer Service

Tallahassee Recreational Park
02.2001 - 06.2007

Customer Care Services

TMart Clothing Store
02.1999 - 01.2001

GED -

Texas Education Agency

Medical Billing and Coding -

Blinn College

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LaShawnda Wilson